<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_rjaic-2020-0015_s_005_w2aab3b7c10b1b6b1aab1c15b1Aa"><h3>Background</h3><p>Combined spinal-epidurals with low-dose intrathecal opioids and local anesthetics are commonly used to initiate labor analgesia due to the fast onset of analgesia and good patient satisfaction. Intrathecal fentanyl has been associated with fetal bradycardia, and the rate may be higher at doses of 25 mcg and above. As such, our institution limits intrathecal fentanyl doses to less than 15 mcg for labor. Prompted by a few incidents of prolonged fetal bradycardia at even these low doses, we sought to audit the side effects associated with varying low doses of intrathecal fentanyl.</p></sec><sec id="j_rjaic-2020-0015_s_006_w2aab3b7c10b1b6b1aab1c15b2Aa"><h3>Methods</h3><p>After IRB approval, a retrospective review was performed on 555 labor records from May–December, 2016. All the patients received combined spinal epidurals for labor analgesia. Intrathecal medication consisted of 1 mL of 0.25% bupivacaine, and varying fentanyl doses: 2.5, 5, 10, and 15 mcg. The incidences of prolonged fetal heart rate decelerations, emergent cesarean delivery, magnitude of pain reduction, pruritus requiring treatment, and hypotension were compared.</p></sec><sec id="j_rjaic-2020-0015_s_007_w2aab3b7c10b1b6b1aab1c15b3Aa"><h3>Results</h3><p>Demographic variables were equivalent between the groups. There were no differences in the rates of prolonged fetal decelerations (in order of increasing fentanyl dose: 4.4%, 2.3%, 7.6%, 3.0%, p-value = 0.11), emergent cesarean delivery, magnitude of pain reduction, pruritus, or maternal hypotension.</p></sec><sec id="j_rjaic-2020-0015_s_008_w2aab3b7c10b1b6b1aab1c15b4Aa"><h3>Conclusions</h3><p>In conclusion, the rates of prolonged fetal heart rate decelerations after combined spinal epidural with intrathecal bupivacaine and fentanyl does not differ for fentanyl doses of 15 mcg and below.</p></sec></abstract>

BackgroundCombined spinal-epidurals with low-dose intrathecal opioids and local anesthetics are commonly used to initiate labor analgesia due to the fast onset of analgesia and good patient satisfaction. Intrathecal fentanyl has been associated with fetal bradycardia, and the rate may be higher at doses of 25 mcg and above. As such, our institution limits intrathecal fentanyl doses to less than 15 mcg for labor. Prompted by a few incidents of prolonged fetal bradycardia at even these low doses, we sought to audit the side effects associated with varying low doses of intrathecal fentanyl.MethodsAfter IRB approval, a retrospective review was performed on 555 labor records from May–December, 2016. All the patients received combined spinal epidurals for labor analgesia. Intrathecal medication consisted of 1 mL of 0.25% bupivacaine, and varying fentanyl doses: 2.5, 5, 10, and 15 mcg. The incidences of prolonged fetal heart rate decelerations, emergent cesarean delivery, magnitude of pain reduction, pruritus requiring treatment, and hypotension were compared.ResultsDemographic variables were equivalent between the groups. There were no differences in the rates of prolonged fetal decelerations (in order of increasing fentanyl dose: 4.4%, 2.3%, 7.6%, 3.0%, p-value = 0.11), emergent cesarean delivery, magnitude of pain reduction, pruritus, or maternal hypotension.ConclusionsIn conclusion, the rates of prolonged fetal heart rate decelerations after combined spinal epidural with intrathecal bupivacaine and fentanyl does not differ for fentanyl doses of 15 mcg and below.

Lower, variable intrathecal opioid doses, and the incidence of prolonged fetal heart rate decelerations after combined spinal epidural analgesia for labor: A quality improvement analysis

Romanian Journal of Anaesthesia and Intensive Care

This work is licensed under the Creative Commons Attribution 4.0 International License.

BackgroundCombined spinal-epidurals with low-dose intrathecal opioids and local anesthetics are commonly used to initiate labor analgesia due to the fast onset...

Lower, variable intrathecal opioid doses, and the incidence of prolonged fetal heart rate decelerations after combined spinal epidural analgesia for labor: A quality improvement analysis

Article Category: Original Paper

Published Online: Dec 31, 2020

Page range: 27 - 33

Received: Feb 24, 2020

Accepted: Sep 21, 2020

DOI: https://doi.org/10.2478/rjaic-2020-0015

Keywords
Fentanyl, fetal bradycardia, combined spinal-epidural

© 2020 Sheena Hembrador et al. published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Lower, variable intrathecal opioid doses, and the incidence of prolonged fetal heart rate decelerations after combined spinal epidural analgesia for labor: A quality improvement analysis

Article Category: Original Paper

Published Online: Dec 31, 2020

Page range: 27 - 33

Received: Feb 24, 2020

Accepted: Sep 21, 2020

DOI: https://doi.org/10.2478/rjaic-2020-0015

KeywordsFentanyl, fetal bradycardia, combined spinal-epidural

© 2020 Sheena Hembrador et al. published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Keywords
Fentanyl, fetal bradycardia, combined spinal-epidural